With ‘sequester’ cuts looming, a look at what’s at stake for public health

Emily Holubowich, executive director of Coalition for Public Health Funding

Last year, as part of the Budget Control Act, a bipartisan, bicameral group of congressional leaders coined the “super committee” was assembled to create a deficit reduction deal that would identify $1.2 trillion in budgetary cuts over the next decade. After several months of negotiations, the ill-fated committee failed to reach an agreement. As a result, across-the-board cuts to defense and nondiscretionary programs over the next 10 years could take effect in January 2013, a term called sequestration. While much of the attention has focused squarely on the impact of defense spending, public health programs could be hit just as hard. With the sequester showdown mounting, does Congress have enough time to stave off the painful cuts? Emily Holubowich of the Coalition for Public Health Funding walks us through some of the cuts in play and how they will impact public health.

With pressure mounting on Congress, how likely is it that they can reach an agreement to avoid sequester cuts?

There is bipartisan agreement that sequestration would be devastating. Unfortunately, there is not bipartisan agreement on how to avoid it. It’s clear that no meaningful action will be taken before the November election. That leaves about 20 working days in the lame duck session to address sequestration and a long list of other fiscal policy issues—including the expiring Bush tax cuts, the expiring “extenders” package which includes employment benefits and payroll tax holiday, the expiring Medicare physician payment patch, and possibly the debt ceiling, not to mention the spending bills for fiscal year 2013. Any one of those items would be a heavy lift in a lame duck session. It’s not clear how Congress will be able to address them all before January 2013. There’s really no way of knowing if they will be able to reach a bipartisan agreement in time. And obviously, the results of the 2012 election will have a huge impact on the outcome.

Across-the-board-cuts of between 8-10 percent to nondefense discretionary funding, as required by the pending sequester under the Budget Control Act, would be disastrous for public health. What programs would be at stake?

Really all public health “programs, projects, and activities” are subject to the cuts. From immunizations to chronic disease prevention, laboratory capacity to training grants, health research to food safety. Public health is already feeling the strain of cuts in federal and state funding. Another 8-10 percent would be the knockout punch.

What is the real-life impact? How might these cuts trickle down to communities, families?

Whether they realize it or not, every American will feel the impact of these cuts. They may have to wait longer to see a healthcare professional in their community. They may have to wait longer for life saving medication. They may be more susceptible to food-borne illness. They may be left waiting longer for help after a natural disaster. And that’s just public health. With fewer air traffic controllers, flights may be curtailed. Classroom size may increase as teachers are laid off. National Parks will have fewer visitor hours. Roads and bridges might not be repaired as quickly. Gang violence and other illicit activity may increase with fewer police officers on the streets.

Would this impact implementation of the Affordable Care Act?

Absolutely. Funding to implement the Affordable Care Act—including the Prevention and Public Health Fund—is subject to the sequester’s across the board cuts.

Can you provide some context for the recent trends we’ve seen in public health funding?

Public health funding at the Department of Health and Human Services has been reduced by 5 percent on average since fiscal 2010. But there is wide variation in that average—the National Institutes of Health has been essentially flat funded, whereas the Centers for Disease Control and Prevention has been cut by 12 percent. We are already seeing the impact of these cuts, most notably, the loss of 55,000 public health jobs.

Health funding in total represents less than 2 percent of all federal spending. These and other “nondefense discretionary” programs like education, public safety, and transportation together represent only 17 percent of all federal spending. They are not the drivers of our nation’s deficit, but they are always easy targets for cuts. To date, all efforts to reduce the deficit have been focused on cutting discretionary programs.

The Coalition is urging its member to be more vocal about highlighting public health’s return on investment. Why is this important at a time when funding is declining?

A budget is more than numbers—it’s a statement of our priorities as a nation. In any political and fiscal environment, programs are in competition for finite resources with each other. It is critical that policymakers understand the impact public health programs have on their constituents if they are to prioritize funding for these programs. The cuts we’ve seen to date send a message – these programs don’t matter as much as others. And our community is partly to blame. We have not sufficiently convinced lawmakers that public health programs are of vital importance to Americans. With sequestration looming, one thing is clear. The public health community cannot afford to be complacent anymore.